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Old 01-04-2011, 02:18 PM
 
Location: Houston, TX
1,610 posts, read 4,303,089 times
Reputation: 1458

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I know you must be thoroughly confused about health insurance in this country - we live here and we're confused. Most of the companies you have mentioned are fairly decent although I have never heard of Celtic. To answer one of your quesitons, the main difference between an HMO plan and a PPO is that the HMO has a much smaller list of providers so you are likely going to be very limited in the number of doctors you can see. The PPO will have a much bigger selection and consequently you pay more for that type of plan. With a very young family like yours, you could probably make do with the HMO since you won't need a wide range of specialists; if you find a decent pediatrician for the kids and a good internist for you and your husband, you could probably do okay. The medical facilities (hospitals) will be pretty much the same for either plan. As for deductibles, the higher yours is, the less premium you will pay.

The way it works is - you pick a plan with the deductible you can afford and beginning either at the first of January or right after your coverage goes into effect you will pay out-of-pocket for regular things like office visits up until you have met your deductible. Then your insurance company will begin to pay a portion of the costs (usually about 70 - 80%) and you will pay the co-insurance portion of 20 -30% up until you hit a certain amount and then most companies will pay 100% after that. Most of the time you'll never reach an amount sufficient to make it to the 100% unless something catastrophic happens. Also be aware that because all the doctors and other providers have negotiated contracts with the insurance companies, they can only charge fixed amounts for their services and they are generally much lower than you would pay if you had no insurance. So even if the doctor "charges" $200 for something, your insurance company may have an agreed-upon limit of $80 so that's what you / the company will be responsible to pay. It's all very confusing but be sure to pay close attention to your agreed-upon coverages and read the EOBs (explanation of benefits) that will be sent to you on a regular basis after services. Keep everything in case there is ever a dispute (I like having mine hole-punched in a binder) and keep each family member's records in its own file (tabs in a binder works well for this). Do some research on the internet for reviews by users of the various companies. You can search for ratings of companies by independent agencies (just Google "rating health insurance companies). If it was me, I would set up a spreadsheet with the company names either down the side or across the top and then include the various categories that concern you and then check the ratings on several sites to see how each company is rated in the various categories. When you find one or more that have consistently high ratings in your important categories, then contact them or even try an independent broker to get quotes from your top choices. With patience and some effort you will be able to find what is best for your family.

I am a big fan of a financial guru named Dave Ramsey who has a daily radio show and advises people about their money issues. He has over time created a list of what he calls ELPs (endorsed local providers) and he even has a category for health insurance. The people on his lists have consistently received high (93% or better) ratings for their various categories of service so that might be another place to look. Here's the link: https://www.daveramsey.com/elp/health-insurance/

Good luck.
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Old 01-06-2011, 08:02 AM
 
119 posts, read 424,046 times
Reputation: 32
I went to Dave Ramsey's website and it needs me to fill in information like name, address, phone number, and email. Is this correct? What happens after I fill in the information? Do I get a email with a list of good health insurance providers?
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Old 01-06-2011, 08:16 AM
 
Location: Houston, TX (Oak Forest)
4,516 posts, read 11,311,550 times
Reputation: 3607
I imagine that your information gets added to a marketing list that Dave Ramsey sells for a profit and people start to call and email you stuff to buy.
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Old 01-06-2011, 08:38 AM
 
Location: Texas State Fair
8,567 posts, read 9,330,054 times
Reputation: 4220
tmc300, as a by-stander, I'd say chris_ut has offered the straightest shot at what you need to know, along with DiverTodd62's 'it depends'.

Think of insurance as more a protective device rather than a consumable commodity. Life Insurance is something of a catastrophic device. It pays on death - the catastrophe. Take health insurance as the same. Pay your own health expense to the extent possible. Doctor's visits (use a clinic), meds (WalMart and generic brands), other cases where you can. Purchase health insurance with the intent that should some 'catastrophic' emergency occur, you'll have coverage for the large expense.

As far as HMO's, PPO's, etc., I've worked in the large corporations where those options were available. IT simply becomes a matter of expectations and preferences. Will you travel to other 'coverage areas', does one plan include your own doctor, what are deductibles, co-pays, coverages, other considerations I don't really recall. I currently have no medical although I visit my physician at a local clinic yearly and purchase meds for blood pressure and cholesterol. Fortunately, I'm not paying for kids. But as a child myself, I visited the doctor twice yearly during my pre-pubescent years for tonsillitis. I was military kid so it was always a clinic and shots of penicillin. I never saw a civilian doctor before I was 21.

Treat your health concerns in a pro-active fashion. Plan to pay your own way. Get coverage for catastrophic conditions.

Consider... whatever we think health insurance in the U.S. is today, it's going to be very different in five years. Plan accordingly.

Last edited by Willsson; 01-06-2011 at 08:50 AM.. Reason: Consider...
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Old 01-06-2011, 08:53 AM
 
Location: Texas State Fair
8,567 posts, read 9,330,054 times
Reputation: 4220
Quote:
Originally Posted by tmc300 View Post
I went to Dave Ramsey's website and it needs me to fill in information like name, address, phone number, and email. Is this correct? What happens after I fill in the information? Do I get a email with a list of good health insurance providers?
When I'm at a website that requires address, etc., I use something like..

300 Main St.
...the capital city of my state...

And for a phone, I use the capital city area code plus 555-1212, which is local phone directory information.

For Houston, that would be Austin, Texas 78701 and the area code 512-555-1212.

Of course, I'll use a correct email, simply for the reply. In a case such as yours, I think I'd create a yahoo email, something like 'myname'meds@yahoo.com, where 'myname' would be your name.

Should necessity require, you could always log back into that account and revise the temporary info.
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Old 01-06-2011, 10:29 AM
 
119 posts, read 424,046 times
Reputation: 32
Good suggestion about filling in the information. Sounds funny but makes good sense.

This is new for us, so I don't know which plan will work best for us. I guess I just have try a plan for one year and then change the plan if necessary after having actual experience.
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Old 01-19-2011, 09:53 AM
 
119 posts, read 424,046 times
Reputation: 32
While shopping for Home & Auto insurance from the internet, I noticed that State Farm also provides Health Insurance. Has anyone had experience using State Farm for their health insurance? If so, is State Farm also a good company to consider buying health insurance from?

Per the sales lady at State Farm, she says that State Farm goes through a company call Assurant Health for health insurance. In this case, sounds like State Farm is just the middle man or broker. Experience would tell me to buy directly from Health Insurance provider, like Blue Cross Blue Shield. What do you think?
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Old 01-19-2011, 09:57 AM
 
Location: Houston, TX (Oak Forest)
4,516 posts, read 11,311,550 times
Reputation: 3607
Experience tells me that you will overpay if you go through State Farm for any type of insurance.
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Old 01-19-2011, 10:17 AM
 
119 posts, read 424,046 times
Reputation: 32
Regarding State Farm, their Home and Auto insurance quotes are higher than the other insurance companies. But the State Farm lady gave me a pretty good sales pitch. She told me that if my house is burned down, State Farm will just give me a check. Other company put a tarp over your house. What do you think?
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Old 01-19-2011, 12:00 PM
 
Location: Houston, TX (Oak Forest)
4,516 posts, read 11,311,550 times
Reputation: 3607
I think that lady gets paid on commission.
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